In the prior art applicants' are aware of U.S. Pat. No. 5,743,885 which issued to Hoerby on Apr. 28, 1998, for Bandage for Fixating an Oral Endo-Tracheal Anaesthesia Tube Relative to the Mouth of a Person and an Assembly for Fixating an Oral, Endo-Tracheal Anaesthesia Tube Relative to the Mouth of a Person. Hoerby discloses the use of a one or two part bandage to support an orally intubated endotracheal tube when the bandage is mounted on the face of a patient. In the one-part bandage embodiments, Hoerby teaches that both the filtrum and mandible of the patient are covered by an adhesively mounted bandage, where the bandage defines an aperture between the filtrum and mandible portions of the bandage. A further, mid-portion of the bandage is supported between the filtrum and mandible portions. The mid-portion is mountable to an endotracheal tube passed through the aperture. There is no teaching or suggestion by Hoerby to use a single fibre-reinforced bridging strip extending between wide plate-like flanges and supporting a centrally disposed pair of arms or wings from the bridging strip so that the bridging strip may be mounted either across the filtrum or across the mandible of a patient so as to allow mandibular or lower facial surgery or upper facial surgery respectively when the tracheal tube is inserted orally, or as to support the tracheal tube when intubated nasally.
In the prior art applicants are also aware of U.S. Pat. No. 5,038,778 which issued Aug. 13, 1991, to Lott for his Endotracheal Tube Tape. Lott discloses the use of a length of one sided adhesive tape having a central non-adhesive portion on the adhesive side of the tape for positioning under the neck of a patient. The opposite ends of the length of tape are brought from behind the neck up on either side of the patient's face and adhesively adhered. The ends of the length of tape are split to provide four strips of tape that are wrapped around the endotracheal tube to secure the tube in place. Other examples of the use of adhesive tape having a central non-adhesive portion and which is intended to wrap behind the neck of a patient and to secure an endotracheal tube to a patient's mouth are found in U.S. Pat. No. 5,306,233 to Glover and U.S. Pat. No. 5,797,394 to Boyd.
In the applicants view any endotracheal tube supporting device that encircles the neck of the patient is likely or prone to abrading the skin of the patient as the patient moves or is moved. Such a device is in applicants view an imperfect compromise between tensioning to avoid accidental and potentially life-threatening extubation and tensioning to avoid skin necrosis caused by decreased tissue perfusion. It is one object to provide anchoring skin fixation of a flexible tube support that does not encircle the neck and which provides minimal or no risk of pressure ischemia. It is a further object of the present invention to provide a support which incorporates an anatomical shape that balances a large surface area for adhesive anchoring on the face with the provision of only a narrow surface area over the filtrum or lower mandible. It is yet a further object to provide reinforcing fibres that inhibit the shearing effects of movement of an intubated tube pulling on the flexible support of the present invention to thereby prevent fracture and separation of the endotracheal tube from the support. Use of prior art multiple-piece supports only complicates the process of fixing the endotracheal tube to the patient and increases chances of incorrect placement and thus the potential failure of the support. The present invention is a one-piece application that is reversible so that it can be applied above or below the mouth to firmly affix the endotracheal tube in place after intubation, and which may be re-oriented by 180 degrees on the filtrum to provide for support of nasotracheal intubation. Use of prior art devices that adhere to the face and which surround the mouth are not appropriate for most types of oral or facial surgery. The support of the present invention may be releasably mounted on the mandible for upper face surgery and on the filtrum for mandible or lower facial surgery. It is yet a further object of the present invention to provide a support which fastens the endotracheal tube in the midline, permitting oral suctioning on both sides of the endotracheal tube and decreasing glottic trauma. Prior art devices which fix the endotracheal tube to one side of the patients mount apply irritating pressure on the patient's vocal cords.